卵巢癌术后高精度持续循环腹腔热灌注化疗的应用

发布时间：2018-06-06 18:47

本文选题：卵巢癌 + 化学疗法　；参考：《贵州医科大学》2017年硕士论文

【摘要】：目的:探讨卵巢癌术后行高精度持续循环腹腔热灌注化疗(HIPEC)应用的安全性、近期疗效及相关影响因素。方法:回顾性分析2015年1月至2016年8月在贵州省肿瘤医院就诊治疗的上皮性卵巢癌患者89例,根据治疗情况分为两组,行HIPEC治疗者46例(研究组),并同时术后联合静脉化疗;单纯静脉化疗者43例(对照组)。统计分析比较分析两组治疗、监测过程中生命体征、血生化及电解质波动情况等安全性指标;分析影响HIPEC治疗灌注次数的相关因素。结果:1、研究组在行HIPEC期间未出现骨髓抑制,后期静脉化疗过程中I-II级毒副反应12例(26.1%),III-IV级毒副反应13例(28.3%);对照组静脉化疗后I-II级毒副反应17例(39.5%),III-IV级毒副反应10例(23.3%);两组对比差异无统计学意义(z=0.354,P=0.723)。两组患者未出现阴道残端愈合不良、肠瘘、感染、肝肾功能损伤等严重副反应。2、术后一个月研究组CA125转阴率45.7%(21/46),对照组37.2%(16/43),X2(P)=0.381(0.537),术后三个月研究组CA125转阴率82.6%(38/46),对照组65.1%(28/43),X2(P)=0.917(0.338),研究组转阴率高于对照组,但统计学无明显差异(P0.05);研究组所有患者CA125值取中位数,术前281.50U/ml,治疗后50.75U/ml,z=5.053、P=0.001、P0.05;分析灌注完成情况,术后仅行一次HIPEC治疗14人,两次6人,完成三次治疗共26人,术前CA125值取中位数分别为230.10U/ml、209.70U/ml、324.45U/ml,HIPEC治疗完成后CA125取中位数分别为52.65U/ml、47.75U/ml、43.852U/ml,z=0.001、0.046、0.001,P0.05,因此虽灌注次数不同,三组患者CA125下降差值均有意义,HIPEC治疗有效。3.影响HIPEC实施的因素:46例实施HIPEC治疗104次,监测治疗过程中生命体征、血生化及电解质波动情,56.5%(26/46)完成三次,13.0%(6/46)两次;30.4%(14/46)仅一次。治疗过程中发生低钾血症发生率8.7%(9/104),低蛋白血症发生率28.8%(30/104),但多未影响腹腔热灌注顺利实施。42.9%(6/14)是因经济原因仅灌注一次,7.14%(1/14)及28.6%(4/14)分别因低钾血症及低蛋白血症未完成治疗;完成两次HIPEC治疗的患者中有16.7%(1/6)因低蛋白血症、50%(3/6)低钾血症而停止后续热灌注治疗,所有患者在口服或静脉补钾及白蛋白后纠正,且在治疗过程中均未出现危及生命的严重毒副反应。结论:1、上皮性卵巢癌手术后行高精度持续循环腹腔热灌注化疗治疗安全可行;2、高精度持续循环腹腔热灌注化疗治疗有效,近期疗效优于单纯静脉化疗;3、经济因素是贵州等少数名族地区影响高精度持续循环腹腔热灌注治疗顺利实施的主要因素之一
[Abstract]:Objective: to investigate the safety, short-term efficacy and related factors of high precision continuous circulatory intraperitoneal hyperthermic perfusion chemotherapy (HIPEC) for ovarian cancer. Methods: a retrospective analysis of 89 patients with epithelial ovarian cancer from January 2015 to August 2016 in Guizhou Provincial Oncology Hospital was performed. According to the treatment conditions, the patients were divided into two groups. 46 patients were treated with HIPEC (study group, combined with intravenous chemotherapy after operation). 43 cases were treated with intravenous chemotherapy (control group). The safety indexes such as vital signs, blood biochemistry and electrolyte fluctuation in the two groups were compared and analyzed, and the related factors affecting the perfusion times of HIPEC were analyzed. Results: 1, the study group had no bone marrow suppression during HIPEC. During the later period of intravenous chemotherapy, there were 12 cases of I-II toxic side effects and 13 cases of III-IV side effects, and 17 cases of I-II grade III-IV side effects after intravenous chemotherapy in the control group (n = 17). There was no significant difference between the two groups in the side effects of I-II grade III-IV and control group (n = 10). There was no significant difference between the two groups. No vaginal stump healing, intestinal fistula, infection were found in the two groups. One month after operation, the negative rate of CA125 in the study group was 45.7%, and that in the control group was 37. 2 / 43%. The negative rate of CA125 in the study group was 82.638 / 46. The negative rate of CA125 in the study group was higher than that in the control group. The negative rate in the study group was higher than that in the control group, and the negative rate in the study group was higher than that in the control group. However, there was no significant difference between the two groups (P 0.05). The median value of CA125 in all patients in the study group was 281.50 U / ml before operation and 50.75 U / ml 5.053U / ml after treatment (P 0.05). According to the completion of perfusion, 14 patients were treated with HIPEC only once, 6 patients were treated twice, and 26 patients completed three times of treatment. The median of CA125 was 230.10 U / ml 209.70 U / ml 324.45 U / ml HIPEC, and the median of CA125 was 52.65 U / ml / ml ~ (47.75) U / ml / ml ~ (43.852) U / ml / ml ~ (0.001) ~ 0.046 ~ 0.001 P _ (0.05), respectively. Therefore, the difference of CA125 in all three groups was significant in the treatment of HIPEC. Factors affecting the implementation of HIPEC: 46 cases were treated with HIPEC 104 times, monitoring vital signs, blood biochemical and electrolyte fluctuations (56.526 / 46) three times (13.0 / 46) twice 30.414 / 46) only once. During the treatment, the incidence of hypokalemia was 8.7% 10 / 10 4, and the incidence of hypoproteinemia was 28.8% or 30% / 104%, but most of them did not affect the successful implementation of abdominal hyperthermic perfusion .42.9% 6 / 14) because of economic reasons only one time perfusion of 7.14% (1 / 14) and 28.6% (4% 14) of hypokalemia and hypoproteinemia did not complete the treatment. Of the patients who completed two HIPEC treatments, 16.7B / 6 stopped the subsequent hyperthermic perfusion therapy because of hypoproteinemia (50% / 6). All patients were corrected after oral or intravenous potassium and albumin supplementation. No serious side effects were found in the course of treatment. Conclusion: it is safe and feasible to treat epithelial ovarian cancer with high precision continuous circulatory intraperitoneal hyperthermic infusion chemotherapy after operation, and the high precision continuous circulation peritoneal hyperthermic perfusion chemotherapy is effective in the treatment of epithelial ovarian cancer. The short-term curative effect is better than that of intravenous chemotherapy alone. Economic factors are one of the main factors that affect the successful implementation of high-precision continuous circulatory peritoneal hyperthermic perfusion therapy in Guizhou and other minority nationality areas.
【学位授予单位】：贵州医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.31

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